A Preliminary Test of Novelty-Facilitated Extinction in Individuals With Pathological Anxiety.

Studies with rodents and healthy humans suggest that replacing the expected threat with a novel outcome improves extinction and reduces the return of conditioned fear more effectively than threat omission alone. Because of the potential clinical implications of this finding for exposure-based anxiety treatments, this study tested whether the same was true in individuals with pathological anxiety (i.e., met DSM-5 diagnostic criteria for an anxiety disorder and/or obsessive-compulsive disorder (OCD). In this preliminary test of novelty-facilitated extinction, 51 unmedicated individuals with pathological anxiety were randomized to standard extinction ( n = 27) or novelty-facilitated extinction ( n = 24). Participants returned 24 h later to test extinction recall and fear reinstatement. Skin conductance responses (SCR) were the dependent measure of conditioned fear. Participants in both groups learned the fear association but variably extinguished it. Novelty did not facilitate extinction in this preliminary trial. Findings underscore the importance of translating paradigms from healthy humans to clinical samples, to ensure that new treatment ideas based on advances in basic neuroscience are relevant to patients.
Competing Interests: In the past three years, HBS reports royalties from Cambridge University Press and UpToDate, Inc. and research support for an industry-sponsored trial of an investigational drug for obsessive-compulsive disorder from Biohaven. She also receives a stipend for her role as Associate Editor of JAMA Psychiatry. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Steinman, Dunsmoor, Gazman, Stovezky, Pascucci, Pomerenke, Phelps, Fyer and Simpson.)